Tony posted recently about what he described as a "
bombshell Louisiana report" on pediatric medical transition. I'd intended to write about that, but as Tony describes the Lousiana report as "
literally the anti-Florida study" and relies on his claim that the "Florida study" was the result of political manipulation, I felt I had to dig into that first. "Enjoy".
Florida
In August 2022, Florida restricted pediatric medical transition. In a Substack article published May 15 Tony writes:
To do this, they relied on a newly created "
Standards of Care" for the treatment of gender dysphoria that was rife with errors and omissions.
Florida Agencies Manipulated Research To Ban Trans Care And Coverage (
archive)
Except Florida has not purported to have written a standards of care (or even a "standards of care" of the joke WPATH kind). The linked document is a summary of several reports commissioned by the Florida Agency for Health Care Administration, one of which was the overview of systematic reviews conducted by the two experts in medical research methods at McMaster University in Canada.
Instead the summary document was a
determination on whether the practices involved in pediatric medical transition (e.g. puberty blockers and cross-sex hormones) meet Florida’s requirements for Medicaid coverage. From the very first paragraph of the document Tony links to:
As a condition of coverage, sex reassignment treatment must be "consistent with generally accepted professional medical standards (GAPMS) and not experimental or investigational" (Rule 59G-1.035 […])
And the final sentence of the document:
Given the current state of the evidence, the above treatments do not conform to GAPMS and are experimental and investigational.
Tony cites a response, written by academics mostly associated with Yale, to the Florida summary document and the reports that back it. SEGM wrote a good thread about the Yale document at the time, which I archived in this post:
SEGM did a good thread about the document, and its lead author Meredith McNamara, last year. […] TLDR; the Yale group didn't even know what GIDS (the largest pediatric gender clinic in the world) was, Meredith McNamara claims to never have met a trans-identified female under 25 who had or even wanted a double mastectomy. Utter jokers.
Tony’s quote includes this bit:
the report is not a serious scientific analysis but, rather, a document crafted to serve a political agenda.
This is the jumping off point for Tony’s main claim, that the Florida AHCA report was written to achieve a political goal. Leaving aside that this is not an unusual way of forming policy (you understand the subject, have a desired outcome, and write a document justifying why that outcome is worthwhile), Tony does not show that this is true in this case.
He (and horse-dildo enjoyer Zinnia Jones) focus on a document written by Andre Van Mol. It’s apparent Van Mol has been updating the document for some time. Jones uses the fact that he found a similar document dated January 2022, with the Florida one dated May 2022, as a "gotcha". But it’s quite clearly Van Mol’s ongoing, extensive notes on the whole subject. I’ve attached it to this post, it looks like a good way to get someone who is skeptical of transition up to speed.
(Van Mol appears to have billed the Florida AHCA $6,000 for providing this document. The ethics of that are questionable, but that’s not our concern here!)
Tony claims:
This [the Van Mol] document houses much of the now-known-to-be deliberately distorted research that Yale scientists denounced as flagrantly unscientific.
The Van Mol document is almost entirely lists of papers, summaries of the findings, citations to those papers, with some of Van Mol’s own commentary. There are a lot of papers in there, including ones Tony has cited approvingly. The Yale response is mostly focussed on the McMaster overview of systematic reviews, and judges the McMaster document by the wrong (and technical) criteria (it is not a systematic review itself); see the previously linked SEGM thread for details.
So what does Tony actually mean here? That Andre Van Mol provided the Florida AHCA with a document, which was then used by two entirely independent experts in Canada to fake their own document? Tony is essentially accusing the two McMaster researchers of "deliberately distorting" their paper to fit a particular viewpoint in Florida.
Tony himself has never really addressed the content of the Brignardello-Petersen & Wiercioch paper. Indeed, in this very article, he doesn’t touch it, instead insisting that Florida’s "standards [sic!] lean heavily on criticisms from a single doctor, Dr James Cantor, while overlooking studies that demonstrate the effectiveness of gender-affirming care in reducing suicides." Here’s
the Cantor paper, which is more a narrative description of the current situation, with some historical background. Cantor is a subject-matter expert involved in this field for 25 years, so it’s appropriate for him to write this.
The meat of the assessment (as a reminder: to be used to judge whether these treatments are experimental and so do not qualify for Florida Medicare) are in the Brignardello-Petersen & Wiercioch overview of systematic reviews.
Tony writes:
All justifications for this approach [psychotherapy rather than medical transition], including the dependence on Cantor, can be traced back to the documents from the American College of Pediatricians (ACP) that Dr. Van Mol utilized and passed on to the Florida Agency for Healthcare Administration (AHCA).
But, again, Tony misunderstands what is going on here. The Florida AHCA has set out to determine whether the treatments involved in pediatric medical transition are "consistent with generally accepted professional medical standards (GAPMS) and not experimental or investigational". The load-bearing work in judging this is the
Brignardello-Petersen & Wiercioch paper, where they assess "information from 2 systematic reviews on puberty blockers, 4 on cross-sex hormones, and 8 on surgeries."
In summary, this is what they found on puberty blockers (from p3 of their report):
For most outcomes (except suicidality), there is no evidence about the effect of puberty blockers compared to not using puberty blockers. […] There is very low certainty about the effects of puberty blockers on suicidal ideation. […] Low certainty evidence suggests […] people with gender dysphoria experience a slight increase in gender dysphoria, and an improvement in depression, and anxiety.
And cross-sex hormones:
For almost all outcomes (except breast cancer) there is no evidence about the effect of cross sex is hormones compared to not using cross sex hormones. […] Low certainty evidence suggests that after treatment with cross-sex hormones, people with gender dysphoria experience an improvement in gender dysphoria, depression, anxiety, and suicidality. There is very low certainty evidence about the changes in quality of life.
And surgery:
There were no systematic reviews and studies reporting on gender dysphoria, depression, anxiety, and suicidality. Therefore, the effects of surgeries on these outcomes (when compared to a group of patients with gender dysphoria who do not undergo surgery), or the changes in these outcomes (improvements or deterioration) among patients who undergo any gender-affirming surgery is unknown. There is low certainty evidence suggesting that a low percentage of participants experience regret, and very low certainty evidence about changes in quality of life after surgery.
When there is no evidence showing that a proposed treatment is better than
not using the treatment, then it is right to call that treatment experimental.
This is at least the second time Tony has spent time writing about the Florida study, and yet he has never engaged with the content of the Brignardello-Petersen & Wiercioch paper.
Despite this, he condemns anyone who references the Brignardello-Petersen & Wiercioch paper, including
Jennifer Block in her BMJ article (bizarrely, Tony links to the press release about the article, not the article itself). And, to be clear, Block references the actual McMaster review paper — not any of the things Tony has directly complained about, such as the Cantor paper.
Tony finishes with:
It reveals a striking lack of integrity for those involved in Florida to question the scientific validity of the care standards for transgender individuals, given that the state’s research findings were deliberately tampered with to endorse banning such care.
Tony has not shown this. He’s shown that a doctor that he disagrees with provided a summary document to the Florida AHCA. He has not shown that Brignardello-Petersen & Wiercioch (in Canada!) used this document to guide their findings, that they received the document, or that they were even aware of it. He doesn’t even refer to them by name, or quote from their paper, but any citation of it earns his condemnation, and he dismisses it as "done in part by a DENTIST" on Twitter.
The main body of the Brignardello-Petersen & Wiercioch overview of systematic reviews is five (5!) pages long. I am certain that Tony has not read it. But then he has also refused to consider the two NICE (English) systematic reviews, the Swedish systematic review, and the Finnish systematic review. I think this is all very telling about his intellectual honesty.
As well, Tony is an inflexible and paranoid thinker, and it seems that he thinks that anyone who writes a paper that doesn’t agree with his pre-existing views is part of a single globe-spanning anti-trans conspiracy.
Lousiana later today or tomorrow morning maybe. Fisking Tony's articles is exhausting.
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